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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by smart.drug on December 2, 2008, at 10:46:57
Howdy, folks.
As usual, I'm checking in after a long haitus, so an update is in order. To recap, I have Bipolar 2.0 (tm), with possible ADHD and/or a sleep disorder. I have a sleep study coming up, which will hopefully sort things out. First, the list of the happy pills.
Cerefolin NAC, 1 tab with breakfast.
Lovaza 1 gm, 4 times a day with or without food.
Lamictal, 200 mg in the morning.
Provigil, 100-200 mg as needed.
Seroquel 50-150 mg as needed.For a while, I thought I had found the perfect combination for me. Then, about a week ago, I started to get mild anxiety which became pretty severe when I saw me p-doc at my last appointment. I also complained of fatigue and an all-over aches. By the way, my p-doc and I both agree that benzos are bad, so we won't touch them until all other options are exhuasted. So anyway, she decided to add Cymbalta to my regimen.
She gave me three reasons for trying it:
1, it targets core symptoms, namely depression.
2, it helps with pain and fatigue
3, it treats GADWhen I brought up Lyrica, she gave me the death glare and asked why I brought it up. I said that it can also help with pain/fatigue (approved for fibromyalgia, like Cymbalta) and with GAD. She raised her eyebrows and said that it's used in Europe for that, but it's not approved in America for that. Furthermore, she did not think there was enough evidence.
Okay, so here's the point I'm trying to get to. Can anyone please help me? I have the following questions.
1.) Which of the two medications are superior with respect to generalized anxiety disorder, relative to their benefits versus side-effects?
I have tried Lexapro, a seretogenic drug in the past. It did absolutely nothing for my anxiety (which waxes and wanes.) I have reason to believe that Cymbalta won't work for me either. I realize I might psych myself out, but. I will stick to it, grit my teeth through the side-effects, and titrate upwards to the right dose.
2.) Which of the two is superior with regards to bodily fatigue?
3.) Which of the two is more likely to impact cognitive function, either positively or negatively?
Please provide solid references, if at all possible and where available. Any other interesting tidbits, please feel free to share. Thank you for your time and attention, and I appreciate your advice.
Posted by bleauberry on December 2, 2008, at 16:01:24
In reply to Cymbalta vs. Lyrica, posted by smart.drug on December 2, 2008, at 10:46:57
There is no way to compare or predict anything with either of these meds. One can generalize on what happened with other people. But experiences with other people have been all over the map, so again, you can only generalize, and it has zero predictive power as to how things would be with you personally.
That said, Lyrica is a more like a benzo than cymbalta.
Not sure the reluctance on benzos, but personal opinion is that they are the safest of all the meds you mentioned.
Posted by desolationrower on December 2, 2008, at 20:34:28
In reply to Cymbalta vs. Lyrica, posted by smart.drug on December 2, 2008, at 10:46:57
> Howdy, folks.
>
> As usual, I'm checking in after a long haitus, so an update is in order. To recap, I have Bipolar 2.0 (tm), with possible ADHD and/or a sleep disorder. I have a sleep study coming up, which will hopefully sort things out. First, the list of the happy pills.
>
> Cerefolin NAC, 1 tab with breakfast.
> Lovaza 1 gm, 4 times a day with or without food.
> Lamictal, 200 mg in the morning.
> Provigil, 100-200 mg as needed.
> Seroquel 50-150 mg as needed.
>
> For a while, I thought I had found the perfect combination for me. Then, about a week ago, I started to get mild anxiety which became pretty severe when I saw me p-doc at my last appointment. I also complained of fatigue and an all-over aches. By the way, my p-doc and I both agree that benzos are bad, so we won't touch them until all other options are exhuasted. So anyway, she decided to add Cymbalta to my regimen.
>
> She gave me three reasons for trying it:
> 1, it targets core symptoms, namely depression.
> 2, it helps with pain and fatigue
> 3, it treats GAD
>
> When I brought up Lyrica, she gave me the death glare and asked why I brought it up. I said that it can also help with pain/fatigue (approved for fibromyalgia, like Cymbalta) and with GAD. She raised her eyebrows and said that it's used in Europe for that, but it's not approved in America for that. Furthermore, she did not think there was enough evidence.
>
> Okay, so here's the point I'm trying to get to. Can anyone please help me? I have the following questions.
>
> 1.) Which of the two medications are superior with respect to generalized anxiety disorder, relative to their benefits versus side-effects?
>
> I have tried Lexapro, a seretogenic drug in the past. It did absolutely nothing for my anxiety (which waxes and wanes.) I have reason to believe that Cymbalta won't work for me either. I realize I might psych myself out, but. I will stick to it, grit my teeth through the side-effects, and titrate upwards to the right dose.
>
> 2.) Which of the two is superior with regards to bodily fatigue?
>
> 3.) Which of the two is more likely to impact cognitive function, either positively or negatively?
>
> Please provide solid references, if at all possible and where available. Any other interesting tidbits, please feel free to share. Thank you for your time and attention, and I appreciate your advice.ok, well a couple of things. Neither really seem useful for fatigue, at least where they have strong evidence, not just anecdote or theory. Two, i'd be somewhat concerned with cymbalta since youi're bipolar, i'd prefer taking a non-sri/nri/snri type drug if there is another option. Do you have addiction problems that make you wary of the benzos? Those do not have evidence of causing destabilization. So, lyrica woulud be preferable for anxiety, especially if it comes and goes; it can be taken more on a prn fashion where cymbalta would not have that option.
As for the 'aches/fatigue' - do you ahve fibro or something, or is this a result of the GAD? If just the latter, then i can see the benefit of pregabalin; i don't know to what extent PRN pregabalin would help with a more formal fatigue or pain disorder.
Cognitivly, i'd expect cymbalta to be better than the sri you had; for someone with adhd i'd think the norephinephrine reuptake would be helpful - pure nris like strattera are prescibed for that. It is probably a personal matter whetehr that will outweigh the foggyness i'd expect from the sri part of it. Lyrica is a stronger relative of neurontin - this has been nicknamed 'morontin' for the cognitive effect. But, some people don't experience them. Like a benzo, if it helps reduce anxiety so you can think clearly it could help, but too much or just bad reaction could make you forgetful and confused. Like bleuberry said it can vary person to person. One problem with treating 'fatigue' is that most treatments have some liability to cause mania, its just par for the course. Even something like creatine has had case reports like that. Also for cognitive problems, is that a problem now, or just a concern? It might be treatable with something mild like a nootropic, rather than forcing a different medicine that is less effective for your main symptoms.
-d/r
Posted by softheprairie on December 3, 2008, at 4:32:46
In reply to Cymbalta vs. Lyrica, posted by smart.drug on December 2, 2008, at 10:46:57
Perhaps a beta blocker for the anxiety? (The one I'm on, nebivolol/Bystolic, prescribed to counter the racing heartbeat caused by my antidepressant desipramine, also helped decrease the anxiety I get from desipramine.) Beta blockers are no help for the fatigue, though.
Posted by antigua3 on December 3, 2008, at 8:50:29
In reply to Cymbalta vs. Lyrica, posted by smart.drug on December 2, 2008, at 10:46:57
I was on a combo of Cymbalta and Lyrica for more than a year, and it worked great for me. I'm coming off the Cymbalta now because it seems to have turned on me (makes me too agitated), but my pdoc said to continue w/the Lyrica for now. I expect the Lyrica will become too tiring once I'm off the Cymbalta, but pdoc said let's treat one drug at a time.
Anyway, it was a great combo for me when it worked.
antigua
Posted by Phillipa on December 3, 2008, at 12:28:21
In reply to Re: Cymbalta vs. Lyrica » smart.drug, posted by antigua3 on December 3, 2008, at 8:50:29
Antigua your meds turned on you too as benzos have turned on me after 37 years now fatigue. Love Phillipa
Posted by smart.drug on December 3, 2008, at 20:46:23
In reply to Re: Cymbalta vs. Lyrica » antigua3, posted by Phillipa on December 3, 2008, at 12:28:21
Well, my psychiatrist asserts with strong conviction that benzos are strong mood destabilizers and that she never gives them to bipolar patients. In fact, one time before when I thought I was having a hpomanic episode, the on-call doctor gave me Klonopin. My own p-doc flipped out and made me turn in the medication. I can't speak for her, but that's what she said.
I'm myself totally biased against benzos for two reasons. One, they suppress slow-wave sleep. Bad idea for me, because my sleep is out of whack to begin with. Two, although they "work" you _will_ build tolerance to them. It's just a matter of time. They have their place in emergencies, and yes, they're "safe," but long-term is a different ball game.
I would have preferred Lyrica, only because it enhances slow-wave sleep. It has a lower abuse potential than benzos. I've struggled with depression my whole life, even as a child; I _really_ don't want to add an addiction to my baggage. Anyway, I'm curious if a bedtime-only dose might give me better sleep, and thus enhance alertness in the morning.
In the meantime, I'll be a compliant patient and do as the doc told me. I intend to stick with the Cymbalta and titrate up after a week. So far, it's making my anxiety worse. I think it worsens sleep quality too... ugh...
This is the end of the thread.
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